Membership Registration

I. Personal Data
First Name: *
Last Name: *

II. Business Data
Business Name: *
Title: *

III. Contact Information
Street: *
City: *
State: *
Zip: *
Phone: *
Fax:
Email: *

IV. Demographic Information*
* This information is optional and will only be used to create a composition profile. All information will be kept in strict confidence.
Sex:
Date of Birth (mm/dd/yy):

V. Opportunities
Please select below which opportunities you are applying to join.
Level:
Charter Membership: will grant you the opportunity to have your name on our website charter member page, VIP tickets to our kick-off event in January 2010, and tickets to our fall fundraiser. In addition, all general membership benefits as listed below.
General Membership: permits invitation to all Young Chamber events at a discounted rate, exclusive access to website, E-newsletters, unique social networking opportunities, professional growth, member only events and programs, committee membership opportunities, and leadership development.
Student Membership: only available to students currently enrolled in a college or university. Must be at least 21 years old to join.

VI. Additional Information
I accept the terms and conditions of membership with the AYC.
Please email me the latest updates on AYC news and events.
Please text me that latest updates on AYC news and events.
What other organizations are you involved in?



Please note that all sales are final.